title: Recurrent Guillain-Barré syndrome.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but recurrences do occur in a presently undefined subgroup of patients.
  
  
  OBJECTIVE
  To determine which subgroup of patients develops a recurrence and to establish whether preceding infections and neurological symptoms are similar in subsequent episodes.
  
  
  METHODS
  A recurrence was defined as two or more episodes that fulfilled the NINCDS criteria for GBS, with a minimum time between episodes of 2 months (when fully recovered in between) or 4 months (when only partially recovered). Patients with a treatment-related fluctuation or chronic inflammatory demyelinating polyneuropathy with acute onset were excluded. The clinical characteristics of recurrent GBS patients were compared with those of 476 non-recurrent patients.
  
  
  RESULTS
  32 recurrent GBS patients, who had a total of 81 episodes, were identified. The clinical symptoms in a first episode were similar to the following episodes in individual patients, being GBS or its variant Miller Fisher syndrome (MFS) but never both. While neurological symptoms in subsequent episodes were often similar, the severity of the symptoms and the nature of the preceding infections varied. Recurrent patients (mean age 34.2 years) were younger than non-recurrent patients (mean age 46.9; p = 0.001) and more often had MFS (p = 0.049) or milder symptoms (p = 0.011).
  
  
  CONCLUSIONS
  Genetic or immunological host factors may play an important role in recurrent GBS, since these patients can develop similar symptoms after different preceding infections. Recurrences occur more frequently in patients under 30, with milder symptoms and in MFS.
authors.affiliation: Erasmus MC, Department of Neurology, s-Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, The Netherlands. k.kuitwaard@erasmusmc.nl
authors.forename: K
authors.initials: K
authors.lastname: Kuitwaard
authors.forename: R
authors.initials: R
authors.lastname: van Koningsveld
authors.forename: L
authors.initials: L
authors.lastname: Ruts
authors.forename: B C
authors.initials: BC
authors.lastname: Jacobs
authors.forename: P A
authors.initials: PA
authors.lastname: van Doorn
mesh_terms: D000328:Adult; D017677:Age Distribution; D003391:Cranial Nerves / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index